Management Strategies for Hyperglycemia Associated with the α-Selective PI3K Inhibitor Alpelisib for the Treatment of Breast Cancer

Tsvetalina Tankova, Elżbieta Senkus, Maria Beloyartseva, Simona Borštnar, Doina Catrinoiu, Mona Frolova, Alinta Hegmane, Andrej Janež, Mladen Krnić, Zoltan Lengyel, Yiola Marcou, Laura Mazilu, Bela Mrinakova, Ruth Percik, Katarina Petrakova, Gábor Rubovszky, Margarita Tokar, Eduard Vrdoljak

Research output: Contribution to journalReview articlepeer-review

13 Scopus citations


Alpelisib is an α-selective phosphatidylinositol 3-kinase inhibitor used for treating hormone receptor-positive (HR+), human epidermal growth receptor 2-negative (HER2–), PIK3CA-mutated locally advanced or metastatic breast cancer following disease progression on or after endocrine therapy. Hyperglycemia is an on-target effect of alpelisib affecting approximately 60% of treated patients, and sometimes necessitating dose reductions, treatment interruptions, or discontinuation of alpelisib. Early detection of hyperglycemia and timely intervention have a key role in achieving optimal glycemic control and maintaining alpelisib dose intensity to optimize the benefit of this drug. A glycemic support program implemented by an endocrinology–oncology collaborative team may be very useful in this regard. Lifestyle modifications, mainly comprising a reduced-carbohydrate diet, and a designated stepwise, personalized antihyperglycemic regimen, based on metformin, sodium–glucose co-transporter 2 inhibitors, and pioglitazone, are the main tools required to address the insulin-resistant hyperglycemia induced by alpelisib. In this report, based on the consensus of 14 oncologists and seven endocrinologists, we provide guidance for hyperglycemia management strategies before, during, and after alpelisib therapy for HR+, HER2–, PIK3CA-mutated breast cancer, with a focus on a proactive, multidisciplinary approach.

Original languageEnglish
Article number1598
Issue number7
StatePublished - 1 Apr 2022
Externally publishedYes


  • PIK3CA-mutated metastatic breast cancer
  • adverse effect
  • alpelisib
  • hyperglycemia

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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